So there I am on the male medical ward at the Kapsowar Hospital this afternoon… trying to verbally redirect the bipolar patient in a manic phase when the Nairobi radio station in the background starts playing Teresa’s and my wedding song. Nothing like a little Shania Twain to soothe the psychiatrically needy.
Medicine here is closer than I thought it would be to the western model. Fair range of medicines in the pharmacy, lab with most of the basic tests and simple xray. But it is farther away than is comfortable: most of the medicines are 3rd or 4th line options for usual conditions, the lab does not offer advanced tests, the portable u/s is mine to use but after confirming the presence of a liver, two kidneys and a cephalic baby lie, I get flummoxed.
Kapsowar has been blessed with greater than a decade of service from a general surgeon with a plastics fellowship who just happens to do what is necessary for ortho/gyne/urology cases. I watched a cleft lip repair on a 6 month old yesterday. A second general surgeon from the US is available plus two Kenyan medical officers trained in general medical issues (and with c-section skills), midwives for maternity, and this month, a scattered few medical students from Britain or the US, a GP with lots of mission experience from Sherwood Park (same church we got married in) and a GP-Anesthetist (the author). Most of the anesthesia is done by two Kenyan nurse anesthestists who have good skills but….organizationally challenged in the drug and equipment drawers (I was taught this was a safety no-no). One is leaving and so I will take some of the call he would have had in June.
To date, I have dealt with pressure ulcers, malnutrition/pellagra, cryptococcal meningitis, organophosphate poisonings (suicide attempts), third degree heart block (3-7 hrs of driving from here gets you a pacemaker), fractured ribs,anemia, anemia, anemia (everyone from the valley is iron deficient), lung cancer (presumed as we only have basic xray – no CT, no biopsy), duodenal ulcers and one very funny manic guy. I am the EKG tech and the med order entry guy and the chase the RN/lab/xray to overcome inertia in task mgmt guy. Having said all that, I have had tea with more employees of the hospital than I can count, I know more RN’s names here now than I ever likely will in Kamloops, and everybody smiles. The pulse oximeter I brought with me is very helpful so I do not have to wait for the hospital’s only pulse oximeter to come from another ward. ICU style resuscitations are done with 10 other patients and at least as many staff watching.
Great experience so far, lots of collegiality and just enough hiccups and wrinkles to raise eyebrows daily.
See ya, kids’ bedtime. Maybe I’ll sing them a song…